A Physiotherapy Perspective on Management of Degenerative Rotator Cuff Tendinopathy

摘要

Physiotherapists lack confidence in managing patients with shoulder problems, partly as a result of the complexity of presentation and lack of clear understanding of the pathology. Recently, tendon pathology has been proposed to occur in a continuum, with pathologic, imaging, and clinical evidence to support the hypothesis. Rotator cuff pathology in the older population has been demonstrated to relate to a primary degenerative tendinopathy, similar histologically and clinically to degenerative tendinopathies elsewhere hi the body. Evidence to support degenerative tendinopathy as the primary pathology within the subacromial space is growing. Building on this evidence and hypothesis, a model of rotator cuff tendinopathy is presented, with suggestions for conservative management of each stage within the tendinopathy continuum based on tendinopathy management elsewhere in the body. Attention to contributing biomechanical, motor control, muscular strength and endurance, external pain referral, metabolic and psychosocial factors by physiotherapists is discussed within the context of the evidence in support of physiotherapy management of rotator cuff disorders. The current lack of research evidence in support of the proposed treatment protocol is acknowledged.